Adrenal Suppression With Chronic Topical Corticosteroid Use in Psoriasis Patients

Background:Topical corticosteroids (TCS) are typically used for extended periods of time for chrOnic skin conditions, including psoriasis. Chronic TCS use may result in side effects similar to those of systemic corticosteroids. Patients may have subclinical adrenal suppression and be unaware of their risk in the case of serious trauma. Objective: The objective of this study was to investigate the real world effects of chronic TCS use and its effects on adrenal suppression in a chronic disease such as psoriasis. Materials:This retrospective study utilized data from screening visits of a psoriasis clinical trial in which subjects had been on chronicTCS. Results: In this study, subjects with moderate to severe psoriasis affecting 16-20% of total body surface area (BSA) and using high-potency TCS at screening had a lower post-cosyntropin cortisol level (18.83 mcg/dL) compared to those with moderate psoriasis involving 10-15% of total BSA and using lower potency TCS at screening (23.22 mcg/dL; P=0.03). Both subject groups had lower post-cosyntropin cortisol levels compared to normal, healthy adults (P<0.001 for both). Conclusion: This suggests that real world chronic use of high potencyTCS over a larger BSA may result in silent adrenal suppression.